肾小管泌氢功能在肾移植术后应用价值的探讨

Preliminary research of hydrogen ion excretion of renal tubule in kidney transplantation

目的对肾移植患者术后连续10周肾小管泌氢功能进行监测。方法检测26例肾移植患者术前及术后连续10周中段尿pH、HCO3-、NH4+、TA(可滴定酸),计算NAC(净酸)量。结果移植早期肾小管功能恢复快而不平稳,6周后趋于平稳,15例次急性排斥期TA、NH4+、NAC值均显著降低,排斥轻、对激素冲击治疗效果好者各值回升迅速;排斥重、须加用抗胸腺淋巴细胞球蛋白(ATG)或延长激素冲击治疗者恢复较慢。结论肾小管泌氢功能可弥补血清肌酐不能良好反映肾小管功能的不足,能在连续观察中对移植肾急性排斥反应的诊断,特别是对抗排斥治疗的效果判断和预后评估中作为有价值的指标。

Objective To investigation the hydrogen ion excretion of renal tubule in 26 renal transplantation patients for 10 weeks after operation. Methods The medistream urine pH, HCO3^-, NH4^＋ and titration acid （TA） in 26 eases of renal transplant recipients were detected before and consecutively 10 weeks after renal transplantation, and the net acid content （NAC） was calculated. Results The function of renal tubule was recovered soon but unsteadily in the early stage after transplantation, and tended to be stable after 6 weeks. The levels of TA, NH4^＋ and NAC were significantly lower in 15 cases of acute rejections episodes. The levels were increased quickly in recipients with mild rejection and good therapeutic efficacy to steroids, but slowly in those with severe rejection, requirement of anti-thymic lymphocyte globulin （ATG） or resistant to steroids. Conclusion The function of hydrogen ion excretion of renal tubule may be a better parameter than serum creatinine in reflecting the renal tubule function. It will be useful in the diagnosis of acute rejection during the consecutive observation, especially in the judgement of antirejeetion therapy and evaluation of prognosis.